Purpose :
Invasive orbital aspergillosis, a potentially fatal disease, is especially rare in immunocompetent patients who live in temperate or cold climates. We sought to characterize several such cases treated at the Massachusetts Eye and Ear Infirmary over an 18-year period.

Results :
The 3 male and 2 female patients, ages 41-76 years (mean 54) lived in New England or northern New York. Four patients had no significant medical conditions, 1 had non-insulin-dependent diabetes. The mean time from symptom onset to diagnosis was 5 months (range 3-9); initial misdiagnoses included bacterial orbital infection, Tolosa Hunt syndrome, optic neuropathy, and idiopathic orbital inflammation. Symptoms in all patients were unilateral headache, eye pain, and decreased vision; 3 (60%) progressed to no light perception vision by the time of diagnosis. All had MRI evidence of orbital apex and cavernous sinus involvement, fungal infection confirmed by biopsy of the orbit or sinus (4 required 2 biopsies for diagnosis), and cultures that grew Aspergillus fumigatus. Patients were treated with prolonged amphotericin and/or voriconazole. Two patients died and three patients recovered fully except 2 of them were left with no light perception vision in the involved eye.

Conclusions :
This study highlights cases of invasive aspergillosis in immunocompetent patients from a relatively cold climate, while most series have been from hot, humid countries such as India. Symptoms of unilateral headache, eye pain, and vision loss may progress slowly. Ocular complaints are common initial symptoms, and increased awareness by ophthalmologists is crucial in providing an early diagnosis.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.